Healthcare Provider Details

I. General information

NPI: 1346353695
Provider Name (Legal Business Name): WAUKESHA HEALTH SYSTEM, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 12/14/2022
Certification Date: 12/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

721 AMERICAN AVE SUITE 501
WAUKESHA WI
53188-5071
US

IV. Provider business mailing address

721 AMERICAN AVE SUITE 501
WAUKESHA WI
53188-5071
US

V. Phone/Fax

Practice location:
  • Phone: 262-928-2396
  • Fax: 262-544-1213
Mailing address:
  • Phone: 262-928-2396
  • Fax: 262-544-1213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number1976
License Number StateWI

VIII. Authorized Official

Name: MR. FREDERICK L SYRJANEN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 252-928-2382